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Indigenous Carers and Community Wellbeing
A Response to the Draft Mental Health Services Plan 2008-2013
Enquiries on this submission may be directed to: Dee McGrath Chief Executive Officer Carers ACT Telephone: (02) 6296 9900 Fax: (02) 6296 9999 Email: [email protected] This document was prepared by: Annemarie Ashton, Policy Advisor Carers ACT sincerely thanks the following Indigenous Carers and Elders for their time, wisdom and expertise in formulating this response: Christine Jard, Dell, Raelene, Meg. Colleen, Isabel, Roslyn Brown and Brenda Hausia. Carers ACT Suite 5 Ground Floor
This work is subject to copyright and may not be reproduced, either in whole or in part, without the prior written approval of Carers ACT Inc. Response to the Draft Mental Health Services Plan 2008-2013 – December 2008 Carers ACT acknowledges that modern day Canberra has been built on the traditional lands of the Ngunnawal People. We pay our respects to their Elders and recognize the displacement and disadvantage they have suffered since European settlement. Carers ACT celebrates the Ngunnawal People’s living culture and valuable contribution to the ACT community.
Unmet Need and Recognition of Mental Illness
10. Medications, Alcohol and Other Drugs
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
Achieving improved social and emotional wellbeing, of individuals, of family and of community, must be a core part for any plan for improving health outcomes for Indigenous people living in the ACT. A positive, strengths based and holistic view of wellbeing better reflects the beliefs system of Aboriginal and Torres Strait Islander peoples and avoids the stigma often associated with terms such as mental illness1. A concept of wellbeing better illustrates the complex connections between individual, family and community, between body and spirit, and between land, culture and the people who belong there. Understanding the holistic concept of social and emotional wellbeing also helps non-Indigenous people to conceptualize the risk factors (e.g. grief and loss) and protective factors (e.g. strength of family connection) which may increase or decrease the chances of an Indigenous person developing a mental health problem2.
Indigenous people in the ACT have significantly higher rates of chronic illness and disability than non-Indigenous people, contributing to a lifespan that is 17 years shorter than the national average. The ABS/AIHW report into the health and wellbeing of Indigenous Australians states “Aboriginal and Torres Strait Islander Australians typically experience higher rates of disability and long-term health conditions and hospitalisation than do other Australians … after taking account of age differences between the Indigenous and non-Indigenous populations, the level of need for assistance among Indigenous people overall was almost twice as high as that among non-Indigenous people”3.
Indigenous people are also more likely to be providing care for family members and others in their community. The ABS/AIHW report into the health and wellbeing of Indigenous Australians also states “After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, Aboriginal and Torres Strait Islander people were more likely than non-Indigenous people to be caring for another person” 4. The median age of Indigenous Carers reported by the ABS/AIHW was 37 years; 12 years less than the median age of non-Indigenous carers (49 years), this is a reflection of higher birth rates at younger ages, and the earlier onset of many chronic diseases in the Aboriginal and Torres Strait Islander population.
In the Australian Capital Territory, 3,872 people who identified as being of Aboriginal or Torres Strait Islander descent, in Census 20065. This is approximately 1.2% of the ACT population. Carers ACT consulted with eight Indigenous women from the Canberra region regarding the Draft Mental Health Services Plan 2008-2013 and also discussed more effective strategies for community support for both Carers and Consumers. Additional information, to expand on sensitive or complex issues discussed by the group, was sourced from some participants through individual discussion and phone calls following the group consultation. Out of respect for the private nature of many stories and perspectives shared, this report will use de-identified quotations.
All of the women attending the consultation were either respected Elders and/or were currently working in Indigenous community support. All participants had extensive experience and expertise in the issues facing Indigenous Carers. All participants were currently providing care to at least one person or had previously
1 Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet) (2008). Mental Health Promotion and Illness Prevention – Aboriginal and Torres Strait Islander people. Auseinet, Adelaide. http://www.auseinet.com/files/ppei/atsippei.pdf 2 ibid. 3 ABS/AIHW (2008) The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples. Canberra: ABS Cat No. 4704.0 4 ibid. 5 Source: ABS (2008) Census 2006 C-Data online. Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
provided care, and many reported significant health conditions affecting their own wellbeing.
Consultation indicated that Indigenous Carers in the ACT have high care support needs as they commonly face more complex care situations, poor personal health, and systemic financial disadvantage creating huge barriers which prevent them from accessing services. The need for culturally appropriate wellbeing services, delivered by Indigenous people who have access to needed training, sufficient resources and ongoing workplace support, is paramount. Indigenous Carers need to build a relationship with a service provider that is mutually trustful and respectful before they can effectively access services. The consultation process has identified a number of systemic barriers preventing access to appropriate and effective care for mental illness. These issues are discussed in relation to the Draft Mental Health Services Plan 2008-2013 and a list of 20 recommendations from Indigenous Carers and Elders on more effective ways to support Indigenous Consumers and Carers is presented for consideration.
2.Carers ACT’s Indigenous Carer Program
Carers ACT’s Indigenous Carer Program provides support to people from the Indigenous community in Canberra who are providing care for someone caring for a family member or friend who has a mental illness, a disability, a chronic physical illness or long-term chronic condition, who has palliative care needs or who is frail and aged. The program provides information, support, brokered respite services, care coordination services to support Indigenous Carers in their caring role. The program aims to support the social and emotional wellbeing of Indigenous Carers and their families, while also providing practical assistance to help meet the challenges of complex care situations.
In partnership with the Aboriginal Corporation for Sporting and Recreational Activities, the Carers ACT Indigenous Program also operates a monthly support group for Carers and Elders. This program is now well known within the Aboriginal and Torres Strait Islander communities in the ACT. Appointment of experienced coordinators, Roslyn Brown and Brenda Hausia, who are well known and respected members of the ACT Indigenous Community, has greatly increased the success of the program. Roslyn Brown has been employed as an Indigenous Coordinator by Carers ACT for two years. In 2008, Roslyn received the NAIDOC Indigenous Community Sector Worker of the Year, an honour which was highly significant to Carers ACT as a mainstream organisation.
Carers ACT is competent in, providing services culturally appropriate services to Indigenous Carers and in building partnerships with the Indigenous community at many levels. Carers ACT is continuing to build trust with Indigenous families and organisations. Carers ACT also provides cross cultural training to non-Indigenous staff so that services to Indigenous Carers are flexible and tailored to a family and community context. Since June 2007, the number of Carers accessing supports has more than doubled, increasing from 40 to 88 within the year. Funding to increase capacity of the program is currently being sought, as Coordinators report that for each family currently receiving support there is an estimated unmet need of 10 more families in need of support. Culturally appropriate service delivery is vital for effectively supporting Carers, and enabling members of the Indigenous community to live with dignity.
Carers ACT has been an incorporated community organization since 1991 and currently supports in excess of 4,400 caring families across the ACT. Every client entering through any program at Carers ACT has immediate access to a comprehensive range of integrated services. Each of these services offers a flexible response based on individual needs. Staff members at all service points are skilled
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
at respectfully and effectively obtaining information to assess the whole of the client’s situation, before offering additional support options for their consideration. Carers ACT staff members recognise that Carers’ needs change over time, and that innovative strategies may be needed to best support them to ensure their health and wellbeing. At an organisational level, Carers ACT works for the benefit of Carers through active Carer participation and consultation. Carers ACT is highly committed to improving understanding of care situations and developing appropriate supports and resources to enable the sustainable continuation of the caring role.
That ACT Health recognizes that the incorporation of Indigenous people under a Cultural and Linguistically Diverse (CALD) grouping is considered to be culturally inappropriate and disrespectful by many Indigenous people and that the Draft Mental Health Services Plan 2008-2013 and all other ACT Health documents need to be amended to reflect the Indigenous community’s unique and valued status as the first people of Australia, rather than incorporating them under headings commonly used to describe migrant groups.
That the Plan provide greater detail on planned expansion of sub-specialty services for Indigenous people to a level which adequately reflects the priority need for more effective services to be delivered to improve Indigenous people’s social and emotional wellbeing.
That the Planaddress how it will deliver, or assist to deliver, appropriate mental health services under the framework of A New Way: The ACT Aboriginal and Torres Strait Islander Health and Family Wellbeing Plan 2006-2011, especially in regard to strategies 8, 9,10, 11, 19, 21, 27, 29, 30, 31 and 35.
That the Plan commit to mandatory cultural awareness training for all employees of ACT Health, to be delivered by Indigenous people in an ACT-specific context.
That the Plan offer options for improved support to enable Indigenous Carers to learn how to deal with non-Indigenous bureaucracy, and be able to obtain independent advocacy support to achieve more effective outcomes for Carers and families.
That a map of services for Indigenous people with mental illness be developed for Indigenous Consumers and Carers, illustrating to culturally appropriate service availability, liaison support, eligibility and costs.
That a culturally appropriate DVD be produced in the ACT to enable Indigenous Carers to recognize signs of mental illness, to learn when help is needed, and to know where to go for help.
The Plan commit to reducing waiting times for existing public mental health services to enable Indigenous Consumers and Carers to access specialist treatment and care on a more timely and affordable basis.
That the Plan provides more detail on the proposed expansion of services available through Winnunga Nimmityjah for mental health treatment and care, and that this expansion is underpinned by greater levels of supplementary care support through appropriate services.
That the Plan detail a strategy to enable additional Indigenous workers to be trained and supported under the proposed expansion of sub-specialty services.
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
That the Plan offer strategies for more discreet access to mental health services and that flexible service delivery options, such as ‘barefoot workers’, be prioritized.
That the Plan includes a strategy for enabling same gender access for Indigenous Consumers attending appointments with mental health professionals.
That the Plan ensures the complete separation of genders for Indigenous people in all treatment and respite facilities.
That the Plan recognizes the inclusion of the whole of family and addresses their needs in a holistic manner.
That the Plan ensures a more effective integration of physical health services with mental health services for Indigenous Consumers, and provide appropriate information to more effectively support Carers.
That the age group for Older Persons Mental Health Services be categorically lowered for Indigenous Persons to 50+ enabling more suitable services to better address the complex needs created by the interaction of mental illness with early onset age-related physical and health problems, grief and loss, depression, and early stage dementia.
That culturally appropriate information on medications and advice on side effects be provided verbally and in written form to Indigenous Carers and Consumers. Greater follow-up support in the community setting needs to be provided to enable more effective care and treatment, and to monitor /minimize the risk of adverse reactions.
That culturally appropriate information and support on the long term effects of alcohol and other drugs, and greater investment in treatment and prevention programs, be delivered within the Indigenous community.
That the Plan outline a strategy to build trust and re-engage Indigenous people with mental illness who may have had a previous negative experience with care and treatment or who hide their mental illness due to fear of stigma.
That the Plan include a detailed comprehensive strategy to more effectively treat Indigenous people with mental illness and addiction or other dual diagnosis.
4.Recognition of Indigenous People
Concern was expressed at the limited recognition and inclusion of Indigenous people in the Draft Mental Health Services Plan 2008-2013; the most substantial reference being a single paragraph on page 29 on “Addressing the Needs of Culturally and Linguistically Diverse (CALD) groups”. Participants in the Carers ACT consultation stated that they find it culturally inappropriate and disrespectful that Indigenous people were included under a CALD heading. They noted that there is a significant difference between other cultural groups who have migrated to Australia from an external homeland and Indigenous people who have a unique and valued status as the first people of Australia. It was recommended that ACT Health recognize this difference and reflect it appropriately in all documents including the Draft Mental Health Services Plan 2008-2013.
Recognition of the need for expansion of “subspecialty services, e.g. dual disability, Aboriginal liaison” on page 15 was noted, but no further detail was provided later in the plan on specific ways to include, consult and provide for effective services to
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
Indigenous people. This was considered to be highly inadequate given the priority need for more appropriate and effective mental health services to be developed in the ACT for Indigenous People, based on a whole-of-community integrated approach. The participants in the Carers ACT consultation group recommended that sections of the Draft Mental Health Services Plan 2008-2013 relating to the expansion of sub-specialty services for Indigenous people be greatly expanded and adequately reflect the priority need for more effective services to be delivered in Indigenous mental health support.
5ACT Policy and Indigenous People The Draft Mental Health Services Plan 2008-2013 makes no reference to the ACT Government’s strategic policy on improving Indigenous Health A New Way: The ACT Aboriginal and Torres Strait Islander Health and Family Wellbeing Plan 2006-2011 in which ACT Health is identified as a key stakeholder. There is also no detail on how services will be improved and expanded to better meet the mental health needs of Indigenous people and their Carers in accordance with the plan. The Draft Mental Health Services Plan 2008-2013 needs to specifically address how it will deliver, or assist to deliver, services under the framework of A New Way, especially in regard to strategies 8, 9,10, 11, 19, 21, 27, 29, 30, 31 and 35.
Participants at the Carers ACT consultation identified that core issues of privacy, dignity, respect and cultural sensitivity needed to be addressed in all areas of service delivery and planning. Awareness of Indigenous history – both past and recent – was paramount.
“People from the Stolen Generation are still in our families today, it’s real for us, it’s still happening.”
It was considered critical that service planners and workers need to understand the levels of grief and loss experienced by the community. Services must also respect the fact that Indigenous people are working hard at overcoming two centuries of treatment where their identity, heritage and culture was considered to be a source of shame instead of a source of pride. Accordingly, there is a need for non-Indigenous people to build a greater awareness of the learning experiences being undertaken by many people in the Indigenous community, and the work of many Elders to rebuild cultural practices which have been suppressed for generations.
“A lot of our people are still getting over the shame … from being treated as sub-human for so long … our people wouldn’t let you talk your language in town, you’d get a flogging … there was shame in our own language.”
Participants strongly recommended that cultural awareness training, delivered by Indigenous people in the ACT, be mandatory for all employees of ACT Health and delivered to service workers with MHACT as a priority under the Draft Services Plan. Some participants at the Carers ACT consultation also identified a need for improved support and training to enable Indigenous people to learn how to understand and deal with non-Indigenous bureaucracy, achieving more effective outcomes for Carers and families.
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
6Unmet Need and Recognition of Mental Illness Participants had comprehensive knowledge of a huge level of unmet need in the Indigenous community across all levels of health and wellbeing, but particularly in relation to mental illness. They explained that mental illness is often hidden, as it has a high degree of stigma and many families greatly fear the potential of negative consequences from service intervention, such as family break-up and incarceration.
Participants also identified that that needs to be greater awareness across the Indigenous Community of what mental illness is and what it is not – e.g. stroke and intellectual disability. Participants at the Carers ACT consultation recommended that a culturally appropriate DVD be developed on how to recognize signs of mental illness, learn when help is needed and where to go for help. It was felt that such a resource would be of significant value.
“Most people don’t understand that what they are dealing with is a mental illness. If given enough information, they will stick their hand up for support.”
Participants recommended that more appropriate levels of support also be delivered to help build awareness of depression. Participants expressed a perception that the whole community suffers from a form of Post Traumatic Stress Disorder, as many live in a state of fear and anxiety generated by past and current trauma. Community wellbeing for Indigenous people in the ACT continues to be greatly affected by high rates of suicide, depression, domestic violence and substance abuse.
Pattel’s work on culturally appropriate therapy notes that Aboriginal people will often present information from a collective world view rather than an individual perspective6. Understanding the importance of the collective experience is vital for delivering appropriate and effective services and supports. Greater investment is needed in the ACT to expand services for Indigenous people which are delivered by Indigenous people. Such services were considered by participants as most likely to be the only effective way to address the collective distress generated from ongoing traumatic events in the community.
Indeed, the AIHW/ABS 2008 report into The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples states that suicide was the leading cause of death for all Indigenous males in 2001-20057. It stated that Indigenous men aged under 35 had a suicide rate up to four times higher than the non-Indigenous population, and the suicide rate for Indigenous women aged under 25 is five times higher than the non-Indigenous population. Every suicide, every person imprisoned and every child taken into foster care, creates additional grief and loss for the Indigenous community. The level of anger and general distress in the community was also of particular concern to participants at the Carers ACT consultation.
“I notice that we are all dealing with so much anger still. Angry with white people and with our own people too. It’s affecting the young people – we are passing it on.”
6 Pattel, N. (2007) Aboriginal families, cultural context and therapy. Counselling, psychotherapy and health, 3(1), 1-24, May 2007. 7 AIHW/ABS (2008) The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples ABS Cat No. 4704.0 Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
Suicide rates are only one measure of the level of mental illness evident in the community. It is important that ACT Health shares more information on mental health care and treatment with Indigenous communities, and the services providing support, to better identify levels of need and the barriers preventing access. Numbers of Indigenous people accessing in-patient treatment services for mental illness in the ACT were not located in any recently published reports available to Carers ACT. The AIHW/ABS report notes that of all the states and territories, only the ACT and Tasmania were unable demonstrate adequate identification of Indigenous status for people accessing any hospital services8.
Participants in the Carers ACT consultation also recognized the need for Indigenous Carers to be more adequately recognized as a key component of the care and treatment situation. There is often a strong family obligation for Indigenous people to provide care for others, and it is critical that mental health treatment services understand the multiple and competing demands which may be made on Carers. It is not uncommon for Indigenous people to be caring across several generations and for multiple members of their extended family.
“We don’t ‘love’ to care. We are in a situation and we have to deal with it.”
Participants at the Carers ACT consultation wanted culturally appropriate resources for Indigenous Carers which accurately reflect and addressed the lived experience of many care situations. The reality is that many Indigenous Carers have to cope with complex and challenging circumstances. They often struggle to access even the most basic of supports to begin addressing the needs of an Indigenous person with a mental illness.
7Access to Services and Support The need for culturally appropriate wellbeing services, delivered by Indigenous people who have access to needed training, sufficient resources and ongoing workplace support, is paramount. Indigenous Carers need to build a relationship with a service provider that is mutually trustful and respectful before they can effectively access services.
“There was so much bad treatment of people in the past with mental illness and with all the other things too. Most of our people are terrified of what white authorities would do if they knew someone in their family was mentally ill. They may not go to their GP or even tell their GP … If they feel they can trust the workers, then that is a big step.”
Participants considered it paramount that access was improved to help Indigenous Carers know where Indigenous workers and/or culturally aware and appropriate services can be accessed. Carers also needed to know what the eligibility criteria for receipt of services was and what costs were involved before accessing the service, as it can be highly discouraging to make contact and then be turned away due to ineligibility or inability to pay. Participants recommended that a map of services be developed relating to culturally appropriate service availability, liaison support, eligibility and costs for Indigenous people with mental illness.
8 ibid. Response to the Draft Mental Health Services Plan 2008-2013 – December 2008 “You can go to an ordinary GP but they can only refer you. Most people are not working. Specialists are only available with money and ordinary counselors are just not qualified enough to help.”
It was important to participants that there is increased recognition that the costs involved in accessing care and treatment services create a barrier to achieving effective health management for many Indigenous people. Participants in the Carers ACT consultations reported that even basic medical care, such as getting to a General Practitioner appointment, can be too expensive for many Indigenous Carers, and it can be impossible for them to afford longer consultations to discuss concerns about family mental health issues, if they wished to do so. Waiting times for existing publicly funded mental health services are also a significant disincentive, and does not enable care for Indigenous people to be delivered in a timely manner.
Effective support in mental health care also involves recognition that the whole family may be involved with providing an Indigenous person’s care. Participants recommended that care and treatment services learn to consider the needs of the family in a holistic manner. Appropriate support needs to be offered to all members of the family, including children in the household who are at high risk of trauma from witnessing distressing situations. Support must also include ensure that the family understands signs or symptoms of the mental illness where urgent help should be sought, and that they know where to go to obtain that help and will be welcomed when they arrive there. Inclusive health delivery, which views the Carer as a respected part of the treatment team, builds trust. It also facilitates communication, enables more effective planning for discharge, and achieves better outcomes for care in the community.
“As a Carer, I had few strategies for dealing with what was going on … He went in and out of Calvary and PSU and we were always having to deal with suicidal behaviour. Not just me … his brothers did too. They were just both school age kids, coming home and finding he had attempted suicide again. He drank as well as the drugs … skipping from one thing to another … he was aggressive when drinking which was hard to deal with.”
One of the main problems faced by Carers was the intersection between physical health care and mental health care, as many Indigenous people will have complex care and treatment needs. Participants reported that Carers received insufficient information on how to appropriately care for a person with complex physical and mental health needs. There also seemed to be inadequate sharing of information between community nursing and community mental health teams. Participants in the Carers ACT consultation recommended the more effective integration of physical health services with mental health services for Indigenous Consumers, and the provision of more appropriate information to enable Carers to better support them in their caring role.
Participants considered the existing mental health liaison and treatment services at Winnunga Nimmityjah to be chronically under-funded and under-staffed. All participants stated that they preferred to access services through Winnunga Nimmityjah, Ngunnawal Community Care or the Indigenous Carer Program at Carers ACT. Across the board, participants identified a need for more Indigenous workers to be trained through multiple access pathways, such as scholarships, on-the-job training, or mentoring.
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
Participants also strongly recommended greater mentoring and support to enable existing Indigenous workers to stay in their jobs for longer; keeping skills and knowledge in the community. Participants reported that Indigenous service workers often face complex challenges due to their dual role as a community worker and as a member of the Indigenous community. Many existing workers get overwhelmed by community demand ‘out of hours’, and end up being ‘on call’ 24 hours a day leading to a higher risk of ‘burn-out’. The need for debriefing for workers after crisis events in community, such as suicides, was also considered to be highly important by participants at the consultation.
Privacy and dignity for people with mental health issues was a particular concern. Many Indigenous people prefer to approach existing community and health workers privately rather than go to a clinic or office. There was concern about the lack of privacy when attending appointments, as everyone in the general waiting room can see that people are there for a mental health appointment. Participants suggested that consideration be given to allow for means of more discreet access for mental health services and that flexible service delivery options be prioritized under the Plan.
One example of effective flexible service delivery, presented by a participant attending, was the concept of ‘barefoot workers’. These are community wellbeing workers who work outside of a clinic or office environment, being free to move around the community with a broad and visible role in providing general health information and outreach services, but who are also trained to discreetly deliver information and support to Carers and to Consumers about mental illness where (and when) it is most needed.
“We used to provide all that was needed for our people before the white people came. Certain members of the community, men and women, looked after the psychic and spiritual health of all others. We can’t do that anymore. We don’t have the training. We need a recruitment drive across all of Australia, for men and women, to pick the best people in every community and train them up. We also desperately need all of our Elders and mature-age people. They can be isolated, and lonely, and not in good health, stuck in some nursing home far from family and country. We can’t afford to lose them early.”
‘Barefoot workers’ would also enable greater chance of early intervention, help to increase integration of physical and mental health services, promote wellbeing in the Indigenous community, and can even assist in supporting recovery for Indigenous Consumers. It is vital that the ‘barefoot workers’ are Indigenous people, and that they have access to the needed training, resources and supports to enable them to build the necessary long-term relationships based on trust, respect, privacy and dignity with both Carers and Consumers. Such a service would enable better wellbeing across the entire Indigenous community and greatly improve outcomes for people with mental illness.
Participants at the Carers ACT consultation also noted that Indigenous people attending for appointments always need access to a same-gender doctor or service worker, as it is highly inappropriate for Indigenous men and women to discuss personal issues with a person of the opposite gender. Separation of genders was also important in treatment and respite facilities. Participants reported that
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
Indigenous women with mental illness do not feel safe if expected to stay overnight at mixed gender facilities, even where there is nominal separation into male and female wards.
The central reform contained in the Draft Mental Health Services Plan 2008-2013 relates to a restructure of services into a Four Life Stages developmental model. Participants in the Carers ACT consultation noted that a defined age group structure will not accommodate the comprehensive problems faced by Indigenous people with early onset of age-related chronic illness and conditions. These people, and their Carers, are faced with additional problems because they often become caught in the existing gaps between disability services and aged care services.
“My mother had dementia; she had to go all the way to my sister in Griffith for palliative care as there was nothing here to help her. Away from family. Away from her home.”
The AIHW/ABS 2008 report into The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples maintains that patterns for chronic long term health conditions show an “onset some ten years earlier in the Indigenous population than in the non-Indigenous population”9. As such, the Participants in the Carers ACT consultation recommended that the age group for Older Persons Mental Health Services be categorically lowered for Indigenous Persons to 50+ to better address the complex needs created by the interaction of mental illness with early-age onset physical and health problems, grief and loss, depression and early stage dementia. Earlier onset age recognition will better align with other ACT Government and Commonwealth funded services, such as through the Department of Health and Ageing, which now recognize lowered age-limits for Indigenous people in many care and support programs.
10Medications, Alcohol and Other Drugs
Participants advised that effects of medication on Indigenous people could often create challenges, as many people lose trust with services if they have a bad reaction to a medication. Participants advised that there was extensive anecdotal evidence in the community that doses considered usual for non-Indigenous Consumers could produce adverse reactions in Indigenous Consumers, leading to an increased risk of greater trauma being suffered by the Consumer and the whole family.
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008 “Many people go once or twice then they don’t go back. They lose faith if they are having problems or if it’s making them worse.”
Carers also reported that they were given insufficient information on potential side-effects, reactions or options for lower dose or alternative treatments, and did not know who or where to call for help. It is clear that culturally appropriate information and greater follow-up support in the community setting is needed to enable more effective care and treatment and to monitor and minimize the risk of adverse reactions.
“Lots of our people have bad reactions to drugs or have allergies … I was given Prozac following a breakdown. I was never told about side effects. I started seeing things, and thought I was going crazy. This went on for weeks. Eventually I said something to my son and he told me it was the drugs causing hallucinations.”
Participants in the Carers ACT consultation were also highly concerned that alcohol addiction and illicit drug use was causing additional mental illness in the Indigenous community. They reported that they needed more culturally appropriate information and support on the long term effects of alcohol and other drugs, and greater investment in treatment and prevention programs delivered by Indigenous workers within the community. Addiction and substance use both contribute to high levels of family and social disruption. They also increase risks of injury, illness, violence and crime.
Concern was expressed by participants in the consultation regarding the effects of marijuana use in the community, especially among young people who were depressed. Participants also observed that many people with mental illness were using alcohol and other drugs as ‘self-medication’ because they had no access to effective, culturally appropriate, care and treatment services. It was noted that many Indigenous people and their Carers had a distrust of many mainstream services due to negative past experiences and concerted effort would be needed to rebuild trust in the community.
“People have nervous breakdowns … they don’t know what is happening to them. They lose their jobs, lose their families. Then they just hide.”
Participants in the Carers ACT consultation also expressed concern that the Draft Mental Health Services Plan 2008-2013 had very limited information on how people with mental illness and addiction (AOD) would be more effectively treated. They reported that Indigenous people often get caught in the existing gaps between services, and do not receive the coordinated care they urgently need to effectively address mental illness alongside other AOD issues, as one issue cannot be treated in isolation from the other. Growing rates of substance abuse were of significant concern to participants. The AIHW/ABS 2008 report into The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples reports that the rate of chronic risky / high risk alcohol consumption is increasing in Indigenous
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
communities in non-remote areas, growing from 12% of adults in 2001 to 17% in 2004-0510.
Chronic risky / high risk alcohol consumption is also strongly associated with high / very high levels of psychological distress in Indigenous (32% of adults compared to 24% for low risk drinkers)11. Evidence of accelerating levels of alcohol consumption combined with high levels of psychological distress requires a priority response from ACT Health to prevent the chronic illnesses inevitably resulting from these issues. Support programs which effectively address addiction alongside mental illness, without judgment or stigma, must be available at all points of treatment and care for Indigenous Consumers.
The Draft Mental Health Services Plan 2008-2013 offers a blueprint for change which aims to guide and shape the development of an improved and integrated mental health sector in the ACT. Reform is centered on a concept of delivery in the least restrictive environment, and focuses on continuing the shift to care in the community. Carers ACT is highly concerned that care in the community risks being driven by a shortage of beds and skilled staff to provide inpatient care and treatment, rather than being an appropriate and effective option which is in the best interests of the Consumer. Carers ACT contends that any expansion of care in the community must be supported by sufficient investment and resourcing of community care services, which must be funded at a level to attract and retain sufficient numbers of skilled and experienced staff members.
Carers carry a significant workload when supporting a Consumer with mental illness. The care situation, while valued by both Consumer and Carer, can be complex, demanding and have a negative impact on Carers’ health and wellbeing if not adequately supported12. It is vital that Carers receive support that is accessible, affordable, timely and flexible; in order to effectively meet their needs and help them to provide quality care for the Consumer. The impact of the care situation on the wider family and on personal relationships is also known to be adversely affected when care is unsupported. Carers frequently need specialist support to maintain connection to family and community.
When providing care, particularly for mental illness, Carers need to be considered as part of the care and treatment team. They are most likely to be the ones providing the most care, as very few Consumers spend more time as an inpatient than in the community. Carers often have expert knowledge which can assist treating professionals to make an accurate assessment of the Consumer’s level of need. They also have an essential need for appropriate information to help them provide the best care possible when the Consumer is discharged into the community.
Consultation with Indigenous Carers from the Canberra region conducted by Carers ACT indicates that Indigenous Carers in the ACT have high care support needs as they commonly face more complex care situations, poor personal health, and systemic financial disadvantage which create barriers to them accessing services. The need for culturally appropriate services is paramount. Indigenous Carers need to build a relationship with a service provider that is mutually trustful and respectful before they can effectively access services. Consultation completed by Carers ACT on the Draft Mental Health Services Plan 2008-2013 has generated 20
10 ABS/AIHW (2008) The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples. Canberra: ABS Cat No. 4704.0 11 ibid.
12 Cummins, R., et al (2007) The wellbeing of Australians – Carer health and wellbeing. Melbourne: Australian Centre on Quality of Life, Deakin University. Response to the Draft Mental Health Services Plan 2008-2013 – December 2008
recommendations for improvements to the Plan which will greatly improve social and emotional wellbeing for the Indigenous community in the ACT. It is greatly hoped by the Indigenous Carers participating in the consultation, and by Carers ACT, that these practical and relatively simple recommendations are incorporated into a revised version of the Plan.
Response to the Draft Mental Health Services Plan 2008-2013 – December 2008

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Update on Laboratory Testing to Identify Individuals With Inhalant Allergies Anna Wetherbee (President, HW Consulting) Originally published in LAB MEDICINE (Lab Med. 2007;38;649–650). The quality and cost of health care in the United States isand enzymeimmunoassay (EIA) tests that use color development,increasingly a focus of media and political debate. Breakthroughsfluorescence, or ch